Possible initial outbreak in nose

[Rockytj]

Apologies for the details here, but just want to make sure I cover everything.

I tested negative for HSV1/HSV2 via IGG in June 2023 as part of routine STD testing.

On Friday July 14, 2023 I had an encounter with an individual where heavy kissing was involved, he had no sores on his lips, although there was a raised spot on his lips that looked like it might’ve been a scar or skin tag (not red.raw, no blisters, matched the rest of his skin, just raised) I didn’t think too much of this as he generally had lots of moles and things on his skin, and I’ve got a few bumps on my face as well. We did talk about testing and sexual health before and he is studying medicine, so I assumed if he had something going on he would have told me.

Fast forward to July 20, 2023 and I have a small, painful spot in my right nostril. To me it feels like a zit, and since I’ve recently trimmed/plucked nose hairs I don’t think too much of it. That night I meet with a different partner and engage in heavy kissing and oral sex (giving and receiving).

Friday July 21, 2023 I wake up and the lower part of my right nostril is red, swollen and painful. I keep it covered all day with a salicylic acid acne patch, and by Saturday the swelling and most of the redness is gone. It’s at this point I begin to worry that it may be an initial outbreak of HSV 1 and I could have transmitted it to my latest partner.

I made it to the doctor today Tuesday July 25. 2023, and they did not think it looked anything like HSV (it’s healed so much that the doctor didn’t even notice it until I pointed it out), but swabbed it for a culture regardless (in spite of asking for PCR).

It only hurt for about two days at the beginning, there were never any blisters/ulcers, and as it’s healed there’s been no scabbing, just a little dryness.

My question is:
Based on this timeline (6 days after the first encounter) and symptoms (redness, swelling, no blisters), does it sound like this could be a primary outbreak?

Thanks

[Terri Warren]

well, it does sound concerning. I take it that no swab testing was done of the area? it lasted a pretty short time to be herpes, however. Normally speaking, a primary infection would be on your mouth, not in your nose. So given all of this, herpes seems unlikely but you may want to get an antibody test for HSV at some point for greater clarity. And if it comes back, get it swab tested for HSV right away.The IgG test for HSV 1 misses 30% of infections so not very reliable when negative

Terri

[Rockytj]

It was swabbed, I’m currently waiting on results from that. By the time it was swabbed it was just a red patch, and I’m fairly sure the clinician ordered a culture not a PCR.

It did seem like a quick turnaround. I will monitor it and if it recurs get it swabbed when it first pops up.

I will look into getting another antibody test at 16 weeks.

Would it be unusual for it to present just as redness on a primary outbreak?

[Terri Warren]

Yes, I think it would be unusual to present with just redness but if by chance the IgG missed an old HSV 1 infection, and this was a recurrence, then not unusual. Let’s see what the swab test shows.

Terri

[Rockytj]

An additional follow up question: I noticed a small spot on my thigh just above my knee that started off as just some redness and a slight itch, it’s continued to improve, and is now just a red spot, no noticeable blisters (after a week). I thought it might just be an ingrown hair but it’s stuck around a little longer than they normally do (1 week)

Does this sound like it could potentially be autoinnoculation if I was having a primary outbreak elsewhere? I never had blisters anywhere else, but it’s certainly conceivable that I could’ve touched my nose when it was inflamed then scratched my leg.

Also I have had a sore since before my concerning encounter (doctor says likely due to post nasal drip) that has continued, would it be possible to have a primary outbreak occur in my throat, especially if there was already inflammation there?

Thanks

[Terri Warren]

The thing on your thigh does not sound like herpes at all so I don’t think autoinoculation, no.
It is possible to have a primary infection in the throat, yes, if you gave oral sex to someone with HSV 2.

Terri

[Rockytj]

Culture came back negative. And I spoke with my most recent partner, and he’s had nothing pop up in two weeks so I’m feeling more at ease at about that.

I do tend to get fixated and do have some OCD and have been nitpicking every sensation everywhere, noting every red mark etc all over my body: face, legs and groin. Based on my possible exposure (which was none in my legs and groin, just in my lips) it doesn’t make sense for things to be spread out all over my body, and the likelihood of auto inoculation in so many places is unlikely considering how fastidious I am about hand washing. So for now I’m feeling good, and planning on repeating my IGG testing at 16 week, and if anything pops up getting swabbed and PCR tested. It hasn’t helped that I have sensitive skin and recently switched soap which has caused some general irritation as well.

Do those sound like reasonable assumptions/course of action?

Thanks for your help

[Terri Warren]

Your plan of action sounds very reasonable indeed.

Terri

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